| Justin Zaman
House officer
The University College
London Hospitals
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Letter of the month
From student to doctor
Ill prepared for house officer's role
Editor
I read with interest your correspondence on incompetent junior doctors.[1 As new house officers, my colleagues and I feel useless at some point almost every day. It feels as if we are not using any of the theoretical knowledge we acquired at medical school. At one end of the scale it could be something simple like titrating the international normalised ratio (INR) to the dose of warfarin, but at the other end it could be something difficult like cannulating someone having a cardiac arrest.
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What is the solution? Every other student health professional seems to be so much more useful in their discipline than medical studentsstudent nurses actually have a defined role on the wards as do physiotherapists, and dieticians. When have medical students ever been an essential part of a firm? But then, who takes legal responsibility? A crash team would never have a student doing the cannulation, yet on your first day as a house officer you are expected to do it even though you have never been examined on your ability to insert a venflon into a near dead patient with no visible veins. You could be super-diligent and study every drug chart daily and monitor all the daily blood electrolytes. I used to think how nice it would be if someone else wrote down all the daily blood results off the computer for meat first glance a menial task, but then could you blame a medical student for missing that high potassium? Who would be liable?
Medical students are forced to tread a fine line between gaining experience and not getting in the way. Consequently, house officers start their jobs inadequately prepared for the day to day practicalities of the job. The answer may be that the final clinical year should be like a permanent student locum, where you have to face all the daily decision-making of a house officer but with close supervision. This would have to be integrated with teaching. This would be difficult to implement, but I think this would help new house officers feel more competent. Despite having worked hard for my final year district general hospital's exam, I feel there was a big part missing from my training.
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